Individual provider Active NPI

Keith Trumaine Williams, MD

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1831758556
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2022-01955 Issued in NC
Practice address
1900 Scott Ave
Ste 200
Charlotte, NC 28203-6046
Phone
(704) 381-0280
NPI assigned
Jun 6, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2022-01955 NC Primary

Addresses

Primary practice location

1900 Scott Ave
Ste 200
Charlotte, NC 28203-6046

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

2101 Shiloh Church Rd
Ste 101
Davidson, NC 28036-7601
Phone (704) 439-3700

Other practice location 2

3396 Cloverleaf Pkwy
Kannapolis, NC 28083-6992
Phone (704) 403-7740

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kwilliams836407@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191114003577 SC Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 4486086311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2022-01955NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kwilliams836407@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1831758556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SCOTT AVE",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282036046",
            "telephone_number": "704-381-0280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2101 Shiloh Church Rd",
            "address_2": "Ste 101",
            "address_purpose": "LOCATION",
            "city": "Davidson",
            "state": "NC",
            "postal_code": "280367601",
            "country_code": "US",
            "telephone_number": "704-439-3700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3396 Cloverleaf Pkwy",
            "address_purpose": "LOCATION",
            "city": "Kannapolis",
            "state": "NC",
            "postal_code": "280836992",
            "country_code": "US",
            "telephone_number": "704-403-7740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KEITH",
        "middle_name": "TRUMAINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-06",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2022-01955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwilliams836407@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1900 Scott Ave",
            "address_2": "Ste 200",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282036046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.